93 Decision Citation: BVA 93-09433
Y93
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
DOCKET NO. 91-49 476 ) DATE
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THE ISSUES
1. Entitlement to an increased rating for conversion
reaction, currently evaluated as 50 percent disabling.
2. Entitlement to special monthly compensation on account
of the need for regular aid and attendance of another person
or by reason of being housebound.
REPRESENTATION
Appellant represented by: The American Legion
ATTORNEY FOR THE BOARD
Martin F. Dunne, Counsel
INTRODUCTION
This matter comes before the Board of Veterans Appeals
(Board) from rating decisions of the Department of Veterans
Affairs (VA), Nashville, Tennessee, Regional Office (RO).
The veteran served on active duty from July 1942 until July
1945 at which time he received a Certificate of Disability
for Discharge.
A rating decision in August 1991 denied the veteran's July
1991 claim for increased compensation. His dementia was not
considered as related to his service-connected
psychoneurosis. A notice of disagreement with the denial of
an increased rating for psychoneurosis was received from him
in September 1991. A rating decision in mid-September 1991
again denied the veteran's claim. A statement of the case
was sent to him at the end of September 1991. The veteran
filed a substantive appeal in October 1991.
This appeal was received and docketed at the Board in
November 1991. Throughout his appeal, the veteran has been
represented by The American Legion. This organization
presented written argument to the Board in March 1992.
REMAND
Essentially, the veteran contends that his service-connected
conversion reaction is such that more than the currently
assigned 50 percent disability evaluation is warranted. He
further asserts that he is now confined to a wheelchair
because of his psychiatric disability and requires the
regular aid and attendance of another person and is
housebound.
The veteran is entitled to service connection for conversion
reaction, 50 percent, effective from May 1964, and for
dermatitis, 10 percent, effective from December 1960, for a
combined, not added, 60 percent disability rating. The
veteran reopened his claim for a higher evaluation to
include special monthly compensation due to his being
wheelchair-bound. The RO held that the veteran was being
treated primarily for a secondarily developed dementia and
not for his service-connected conversion reaction.
The evidence shows that the veteran was born in April 1905
and is now 88 years of age. On appeal, the veteran's
representative argues that, in light of the veteran's age,
his conversion disorder manifestations were being
interpreted as dementia. The veteran's representative
requests that, prior to final appellate action in this case,
the veteran be afforded a neurological consultation as well
as an extensive psychiatric evaluation by at least two
psychiatrists in order to determine the true nature and
extent of his service-connected conversion reaction
disability. It is also argued that there is some opinion
that long-term psychological disabilities, including
conversion reaction, tend to maturate into or are masked by
dementia. In light of the close similarity between these
two conditions and manifestations thereof, the request is
made that the psychiatrists review the records and examine
the veteran in order to determine whether the veteran has
two separate and distinct psychiatric disabilities or if the
manifestations are symptomatic of a single psychiatric
disability. If a separate psychiatric disability exists, it
must be determined if service connection is in order, as
that issue is inextricably intertwined with the issues now
on appeal. Harris v. Derwinski, 1 Vet.App. 180 (1991).
In reviewing the evidence of record, the Board notes the
veteran has been service connected for a psychoneurosis
since the time he was separated from active duty. Over the
years, the symptoms associated with his conversion reaction
have included defective memory, confusion, periods of
blackout spells, lack of orientation, and somatic
complaints. These particular manifestations had been noted
as early as the 1960's. As early as 1952, his skin
condition had been diagnosed as neurodermatitis.
VA has a duty to assist the veteran in development of facts
pertinent to his claim. 38 U.S.C.A. § 5107(a) (West 1991);
38 C.F.R. § 3.103(a) (1992). The United States Court of
Veterans Appeals (Court) has held that the duty to assist
the veteran includes developing available facts and evidence
to support his claim, including obtaining VA medical
examinations and opinions, when appropriate.
On the basis of the present record, a final decision is
being deferred pending a REMAND for the following action:
1. The RO is to arrange for the veteran
to undergo VA examinations in order to
determine the exact nature and extent of
his psychiatric disorder or disorders.
Any indicated special studies such as
psychological testing should be
accomplished. The examiners are to
express their opinions as to the current
nature and extent of the veteran's
service-connected conversion
psychoneurosis. If the veteran's
service-connected conversion disorder and
any organic dementia are noted to be
present and two separate disabilities,
the examiners are to express their
opinions as to any etiology of the
organic disorder. If the veteran's
psychiatric symptoms are diagnosed as one
disability, a definitive diagnosis is
requested from the examiners. Also, the
records indicate that the veteran is now
wheelchair-bound. Upon examination, an
etiological relationship between the
veteran's status of being
wheelchair-bound and his
service-connected conversion and skin
disabilities is requested. Prior to the
examinations, the veteran's claims file
must be made available for review in this
case. Following conclusion of the
examinations, the examiners' report is to
be incorporated with the veteran's claims
file.
2. The RO is to request that the
appropriate VA medical examination report
be completed noting whether the veteran
needs the aid and attendance of another
person or if he is considered
housebound. This report is to be
incorporated with the veteran's claims
file.
3. When the above-mentioned development
has been completed, the RO is to review
the veteran's claim and adjudicate the
issue of service connection for
additional psychiatric disability.
Following completion of these actions, and if the decision
remains unfavorable to the veteran, he and his
representative are to be provided with a supplemental
statement of the case and afforded the appropriate period of
time in which to respond. Thereafter, in accordance with
the current appellate procedures, the claims file, to
include the additional requested evidence, is to be returned
to the Board for further appellate consideration.
BOARD OF VETERANS' APPEALS
WASHINGTON, D.C. 20420
*
J. E. DAY (MEMBER TEMPORARILY ABSENT)
SAMUEL W. WARNER
*38 U.S.C.A. § 7102(a)(2)(A) (West 1991) permits a Board of
Veterans' Appeals Section, upon direction of the Chairman of
the Board, to proceed with the transaction of business
without awaiting assignment of an additional Member to the
Section when the Section is composed of fewer than three
Members due to absence of a Member, vacancy on the Board or
inability of the Member assigned to the Section to serve on
the panel. The Chairman has directed that the Section
proceed with the transaction of business, including the
issuance of decisions, without awaiting the assignment of a
third Member.
Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the
Board of Veterans' Appeals is appealable to the United
States Court of Veterans Appeals. This remand is in the
nature of a preliminary order and does not constitute a
decision of the Board on the merits of your appeal.
38 C.F.R. § 20.1100(b) (1992).